The proposed 3 year project seeks to study the outcomes and effectiveness of major noncardiac surgery. Support for this investigation is sought at this time because the combination of surgical advances and the aging of the population has led to ambitious operations being undertaken on increasingly complex patients. Uncertainty about the immediate and long-term outcomes from surgery may contribute to variation in the performance of these procedures among physicians and institutions. Detailed prospective clinical and health status data will be gathered during preoperative and postoperative evaluations and during follow-up interviews 1 and 6 months after surgery on 2600 patients aged >50 years undergoing 16 major noncardiac procedures. Analyses of these data will be directed at these specific aims: 1. To determine the rate of adverse short-term (perioperative) cardiac and noncardiac outcomes among patients undergoing major noncardiac surgery. 2. To identify and validate clinical characteristics, socioeconomic factors, and management factors that are predictors of these adverse short-term outcomes. 3. To evaluate the impact of socioeconomic factors and adverse short- term outcomes on length of postoperative stay and other measures of resource utilization after controlling for clinical factors. 4. To assess the long-term effectiveness of high volume procedures by obtaining serial measurements of functional status and health perception pre- and postoperatively. 5. To identify the patient-specific and management factors that are independent predictors of variation in long-term outcomes after high volume procedures. 6. To identify lower volume procedures with marked variability in long-term outcomes that may be appropriate for future research. Analyses for Specific Aims 1-3 will be based upon the entire study population; analyses for Specific Aims 4-6 will focus on subsets who undergo specific procedures. The findings can be expected to help clinicians and patients choose among management strategies, to guide health policy decisions, and to identify issues for future health care research.